The EastAfrican OUTLOOK DECEMBER 20-26,2014 S U S TA INAB L E D E VE LO PME N T GOAL S Mala≥ia mo≥tality high in EA By CHRISTABEL LIGAMI Special Correspondent Children playing with a balloon. Under five deaths have reduced drastically since 1990. Picture: File THE NUMBER of people dying from malaria remains high in East Africa despite WHO reports that the number of people dying from malaria globally has fallen sharply. According to the WHO Malaria Report 2014, about 20,000 deaths were reported in East Africa in 2013 with Kenya, Uganda and Tanzania ranked among the countries in sub-Saharan Africa accounting for 90 per cent of the estimated number of P. falciparum infections by number of infections in all ages. Tanzania, Uganda and Burundi, Dealing with neonatal deaths, ce≥vical cance≥s must info≥m new sma≥t ta≥gets I n a world where there are so many worthwhile targets demanding our attention, we need to focus on those where we have the best chance of doing the most good. How about saving more than 14 million newborn by 2030? That’s a pretty eye-catching figure but one that the author of a new analysis for the Copenhagen Consensus believes is not only achievable, but also highly cost-effective. Günther Fink, from the Har- vard School of Public Health, is one of more than 60 expert economists my think tank has asked to make the case for that the world’s governments and the UN are currently debating. These will shape global progress over the next 15 years, so it’s important to get them right. Is it really possible to make such a dramatic difference to the survival of newborn babies? Past experience would suggest that it is. UN figures show that nearly 18 million children around the world died before reaching the age of five in 1970, while in 2013 that figure had come down to just above 6 million. Tougher targets? This is still way too high, of course, but it’s nevertheless a very impressive figure, even more so when we realise that the number of births annually has increased during those 40 years. In 1990, nearly 50,000 children died before their fifth birthday each year in Rwanda. Today, that number is down COMMENTARY DR BJØRN LOMBORG Deaths in the first seven days after birth are virtually onethird of all under-5 deaths; premature birth accounts for half of these. to 22,000. The problem is that the more progress you make, the harder the remaining targets are to reach. Much of the progress in controlling infant mortality since 1970 has been in areas such as controlling infectious diseases and improving nutrition. Progress in this should and will continue but this won’t be as rapid as before. It’s a sobering thought that, with the current birth rate, under5 mortality would still exceed 4 million each year even if all infectious diseases were eradicated. One of the biggest chal- lenges going forward will be providing high quality care to newborns, particularly to those born too early and with low birth weight. Deaths in the first seven days after birth are virtually one-third of all under-5 deaths, and premature birth is the biggest single cause, accounting for half of these. As well as the perils of pre- maturity, birth complications and sepsis are significant causes of deaths of young babies. Proper care can have a really big impact but it costs money to build more clinics and train and pay more doctors and nurses: about $14 billion a year to hit the target of a 70 per cent reduction in neonatal deaths, according to estimates. That sounds a lot, but the ben- efits are much bigger at more than $120 billion annually. For each dollar spent, we will help the world’s newborn to the tune of about $9. Reducing infant mortality is not the only good target, of course. One that gets a lot of attention is access to contraception, which enables women to have children when the time is right for them, gives them better employment prospects and enables them to invest more in their children’s future. A dollar spent on this could pay back perhaps 120-fold. But while family planning is high profile, there are other good ways for the international community to invest in women’s health. This was analyzed in another paper from Dara Lee Luca and colleagues from Harvard University. The fourth most common can- cer among women globally is cervical cancer, with half a million cases diagnosed annually and more than 200,000 deaths each year. Some 85 per cent of all cases occur in the developing world, where it is actually the second deadliest cancer among women, after breast cancer. Its impact is particularly great because it also affects younger women who are raising and supporting families. Fortunately, many of these cases are preventable, because nearly all are associated with a viral infection, and a vaccination is available. The vaccine is more expensive than most and three doses are needed but in total, a course of treatment in developing countries would cost $25 per girl. Vaccinating 70 per cent of girls in one cohort throughout most of the developing world would cost about $400 million, and would save 274,000 women from dying, often in the prime of their lives, from cervical cancer. For each dollar spent, we would, do more than three dollars worth of good. For Rwanda, one year of vac- cination would cost about $1.6 million and would avoid 2,000 deaths. Each dollar spent would do $5.46 of good. Health is obviously high on everyone’s agenda but the escalating costs in rich countries show there are no easy answers. Choosing the best targets for the international community to support between now and 2030 is going to be very important if we are to do the most good with the resources available. Dealing with neonatal deaths and cervical cancer could be two of the smart targets we should choose. Dr Bjørn Lomborg, an adjunct professor at the Copenhagen Business School, directs the Copenhagen Consensus Centre, ranking the smartest solutions to the world’s biggest problems by cost-benefit. He is the author of The Skeptical Environmentalist and Cool It. His new book is How To Spend $75 Billion to Make the World a Better Place the report shows, have the highest number of deaths caused by malaria in the region with Tanzania reporting the highest number of 8,526, Uganda 7,277 and Burundi 3,411. Kenya and Rwanda reported the lowest malaria deaths in 2013 of 360 and 409 respectively. Globally, there were an esti- mated 198 million malaria cases in 2013, 82 per cent of which were in the African region. Malaria was responsible for an estimated 584,000 deaths worldwide in 2013, killing an estimated 453,000 children under five years of age. Apart from Rwanda, which re- ported the same number of fatalities as last year, all the East African countries reported an increase in malaria deaths. Testing improves However, the WHO report shows that access to accurate testing and effective treatment has significantly improved worldwide. Analysis across sub-Saharan Africa reveals that despite a 43 per cent population increase, fewer people are infected or carry asymptomatic malaria infections every year: the number of people infected fell from 173 million in 2000 to 128 million in 2013. The report says that between 2000 and 2013, access to insecticide-treated bed nets increased substantially. In 2013, almost half of all people at risk of malaria in sub-Saharan Africa had access to such protection, a marked increase from just three per cent in 2004. Between 2000 and 2013, malaria admission rates decreased by 75 per cent in Eritrea, Rwanda and Tanzania. Given the intense malaria trans- mission in the worst-affected countries, including the East African countries, which saw an estimated 6.6 million malaria cases in 2013, WHO said it has issued new guidelines on temporary measures to control the disease during the Ebola outbreak, including administering anti-malarial drugs even when patients have not been tested for malaria. 31